Facility Evaluation Report

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a case management visit and was greeted by caregiver. Licensee Jenero Jefferson was not available to come to the facility, was not available by phone and their voicemail box was full, so LPA could not leave a message.

On 11/08/24 CCL delivered to licensee substantiated findings of complaint 21-AS-20240605093000 and citations were issued for deficiencies of California Code of Regulations 80062(a)(1) and 80076(a)(1), respectively. The following plan of correction was issued for deficiency of regulation 80062(a)(1): Facility to submit all documents that were originally requested by the CCL auditor no later than plan of correction due date, 11/12/2024. The following plan of correction was issued for deficiency of regulation 80076(a)(1) ): Facility to submit a written plan that indicates how facility will ensure clients have access to the quantity and quality of food required by regulation. Additionally, the facility is to provide a menu for the upcoming week along with grocery receipts showing food items have been purchased related to the menu no later than plan of correction due date, 11/12/2024.

As of today, CCL has not received any documents from licensee fulfilling the plans of correction for deficiency of regulation 80062(a)(1) or 80076(a)(1). Therefore, the deficiencies are being cited today on the attached 809D.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with caregiver. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.

Exit interview conducted with caregiver and a copy of this report was given .